A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer

Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of residual tumour and upstaging in NMIBC after TURBT and to investigate the risk factors for the same.Methods: A prospective observational study was carried out over 4 years and 87 patients were included in the study. Patients with NMIBC underwent RETURBT after 2-6 weeks of primary TURBT. The incidence of residual tumour and upstaging in RETUBRT was correlated with various histopathological and morphological parameters in primary TURBT.Results: Out of 87 patients, who underwent RETURBT, residual disease was present in 51 patients (58.6%) and upstaging occurred in 22 patients (25.2%).On univariate analysis, T1 stage (p=0.01), high grade (p=0.01), Carcinoma in situ(CIS) (p=0.01) and multifocality (p=0.05) were predictive for residual disease in RETURBT. High grade (p=0.01), CIS (p=0.01) and absence of detrusor muscle in specimen (p=0.03) were risk factors for upstaging in RETURBT.Conclusions: NMIBC have high incidence of residual disease and upstaging after primary TURBT. T1 stage, high tumour grade, CIS, and multifocality are risk factors for residual disease after primary TURBT. High tumour grade, CIS and absence of detrusor muscle are strongly associated with upstaging during RETURBT

Acute Liver Failure Due to Etodolac, a Selective Cycloxygenase- 2 (COX -2) Inhibitor Non-Steroidal Anti-Inflammatory Drug Established by RUCAM-Based Causality Assessment

Drug induced liver injury is a common cause of acute liver failure (ALF). While most of these cases are due to dose dependent hepa-totoxicity with acetaminophen, idiosyncratic drug-induced liver injury (DILI) is responsible for about 15% cases of ALF. Antibiotics are the most common cause of idiosyncratic DILI as well as DILI induced ALF. Etodolac is a selective cycloxygenase- 2 (COX -2) inhibitor non-steroidal anti-inflammatory drug used as an analgesic and anti-inflammatory in musculoskeletal diseases. Severe liver impairment is extremely rare. Till date, only 3 cases of ALF related to etodolac have been reported in the literature. Here we report two cases with a unique presentation of ALF occurring due to DILI caused by etodolac, as diagnosed by Roussel Uclaf Causality Assessment Method (RUCAM)

Comparison of Visual Prostate Symptom Score and International Prostate Symptom Score in the evaluation of men with benign prostatic hyperplasia: A prospective study from an Indian population

Background: Lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH) are common conditions in middle-age or older men. The International Prostate Symptom Score (IPSS) is a useful and validated questionnaire to evaluate LUTS secondary to BPH. Van der Walt et al have developed an alternative questionnaire named the Visual Prostate Symptom Score (VPSS) questionnaire. This study aimed to evaluate the relationship between the VPSS and IPSS in the evaluation of men with LUTSs due to BPH in an Indian population. Materials and methods: This was a prospectively designed study conducted at Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram (Anantapur, Andhra Pradesh, India). A total of 121 patients who presented to the urology outpatient department with LUTS due to BPH were enrolled in the study. Patients were followed up at 1-month and 3-month intervals. All patients were given both questionnaires. The correlation test was used to assess the correlation between two symptom scores and various parameters. Observations with a P value < 0.05 were considered statistically significant. Results: There was a statistically significant difference in the number of patients requiring assistance to fill the questionnaires according to their education level. There was a positive correlation between IPSS total score and VPSS total score (r = 0.7235; P < 0.0001), VPSS total score and VPSS quality of life (Qol; r = 0.70753; p < 0.0001), IPSS total versus IPSS Qol (r = 0.65583; P < 0.0001), and IPSS Qol versus VPSS Qol (r = 0.84093; P < 0.0001). A negative correlation was observed between total VPSS with Qmax, total IPSS with Qmax, IPSS total versus Qavg (r = −0.479; P < 0.0001), and VPSS total versus Qavg (r = −0.5; P < 0.0001). All VPSS questions showed statistically significant correlation with the corresponding IPSS questions. Conclusion: There is a statistically significant correlation between the VPSS and IPSS and it can be completed by a greater number of patients without assistance

Screening for visual impairment: Outcome among schoolchildren in a rural area of Delhi

Background: Uncorrected refractive errors are the main cause of vision impairment in school-aged children. The current study focuses on the effectiveness of school eye screening in correcting refractive errors. Objectives: 1. To study the magnitude of visual impairment among school children. 2. To assess the compliance of students for refraction testing, procurement and use of spectacles. Materials and Methods: An intervention study was conducted in schools of the north- west district of Delhi, in the rural field practice area of a medical college. Students studying in five government schools in the field practice area were chosen as the study subjects. Results: Out of 1123 students enrolled, 1075 (95.7%) students were screened for refractive errors. Low vision (visual acuity < 20/60) in the better eye was observed in 31 (2.9%) children and blindness (visual acuity <20/200) in 10 (0.9%) children. Compliance with referral for refraction was very low as only 51 (41.5%) out of 123 students could be tested for refraction. Out of 48 students, 34 (70.8%) procured spectacles from family resources but its regular use was found among only 10 (29.4%) students. The poor compliance among students stems out of various myths and perceptions regarding use of spectacles prevalent in the community. Conclusion: Refractive error is an important cause of avoidable blindness among rural school children. Behavior change communication among rural masses by spreading awareness about eye health and conducting operational research at school and community level to involve parent′s teachers associations and senior students to motivate students for use of spectacles may improve utilization of existing eye health services in rural areas

Monocyte human leukocyte antigen – Antigen D related, neutrophil oxidative burst and cytokine analysis in patients of decompensated cirrhosis with and without acute-on chronic liver failure

<div><p>Background and aim</p><p>Due to a dysregulated immune response, patients with acute-on-chronic liver failure (ACLF) have increased risk of infection and multi organ failure in comparison to compensated cirrhosis. The comparative data on the presence of ‘immune paresis’ in patients with ACLF and decompensated cirrhosis without ACLF is not available. Aim of the present study was to compare the immunological parameters in patients with decompensated cirrhosis with and without ACLF.</p><p>Methodology</p><p>In a prospective study, 76 patients with decompensated cirrhosis with (n = 38) and without (n = 38) ACLF and 10 healthy controls (HC) were evaluated for monocytic human leukocyte antigen–antigen D Related (HLA-DR) expression, mean density of HLA-DR expressed on the surface of these cells, neutrophil oxidative burst (NOB) capacity and serum levels of cytokines (IL-1, IL-6, IL-8, IL10, IL-12, and TNF-α).</p><p>Results</p><p>Patients of decompensated cirrhosis with and without ACLF demonstrated significantly lower mean percentage of monocytes expressing HLA-DR and quantitative increase in the NOB after stimulation with PMA when compared to HC. However there was no difference in mean percentage of monocytes with HLA-DR expression (43.61±26.56% vs. 43.10±20.98%) (p = 0.91), mean density of HLA-DR expression on the surface (30.34±29.32 vs. 41.71±52.13) (p = 0.42) and quantitative increase in NOB after stimulation with PMA (16.55±11.91 vs. 17.24±16.18) (p = 0.47) amongst patients with decompensated cirrhosis with and without ACLF. Patients with ACLF had significantly higher pro-inflammatory and anti-inflammatory cytokines in comparison to patients with decompensated cirrhosis without ACLF.</p><p>Conclusion</p><p>Patients with decompensated cirrhosis demonstrate a component of immune-paresis, however there is similar impairment in HLA–DR expression and NOB capacity in patients with and without ACLF. Both inflammatory and anti-inflammatory cytokines are increased in patients with ACLF in comparison to patients with decompensated cirrhosis without ACLF.</p></div

Immunological parameters in patients of ACLF, CLF and HC.

<p>Immunological parameters in patients of ACLF, CLF and HC.</p

Baseline characteristics of patients with Chronic liver failure (CLF).

<p>Baseline characteristics of patients with Chronic liver failure (CLF).</p

Immunological parameters in patients in the survivor and non-survivor group with ACLF.

<p>Immunological parameters in patients in the survivor and non-survivor group with ACLF.</p